41 6th ST RFNC21-0087 e'",„• Building Permit Application Updated 12/8/17
z - . iiCity of Atlantic Beach
'44.t1 800 Seminole Road,Atlantic Beach,FL 32233
11.0
Phone:(904)247-5826 Fax:(904)247-5845 RP-1\\02
Job Address: / Permit Number: I —Oo 7
Legal Description Lot- I ,S I /Z L04' 3/ S SO t- / RE# ( 7 01 1 Z �
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Valuation of Work(Replacement Cost)$ 37.9 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle on . Ne Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No at
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:, i 1/`�� geT
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Florida Product Approval# for multiple products use product approval form
Property Owner Informati n
Name: > -+r /A%2&0 Address:______ / C '
City Art-, 34,r State fe-- Zip Phone 6 31 53 /
E-Mail Le e E j3(d Cep , co M
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Compan : _ • 21 t Qualifyin Agent: /96keies ..-..64.7-_,,,�Addressfl rY € !��., )' •/Q City ,¢X StateZip 3Lz
Office Phone 1 / 34• Job Site/Contact Number �,i � %rtr
State Certification/Registration# E-Mail /7I- 9L3 '7.0-7o6/ .--.7 dz., d ?Pin_
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation S (.) j1-z iv, 7•7
Exempt/Insurer/Lease Employees/Expiration Date
Application is hereby made to obtain a permit to Bothe work andinstallations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS, etc. NOTICE: In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and
there may be additional permits required from other governmental entities such as water management districts,state agencies, or
federal agencies.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY EFORE o_ 1 1
g i
RECORDING YOUR NOTICE OF COMMENCEMENT. / z_ Fj
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(Signature o, ner or Agent) (Si ure of ontractor) w 1
(incl • ude c,,ntractor) q (t
Signed and sworn to(or affir e. bef. - me this /day of Signed and sworn to(or affirmed)before me this` day of 1 -
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[ ]Personally Known OR ��'• �,�=: Pe .Wally Known OR
=.: =•� :, MY COMMISSION#GG 35 f�
[ ]Produced Identification "° :<- EXPIRES:OMMIS October 6,20 Yr. uced Identification
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Type of Identification: U •''FOF•:.oP; - _-" nderwr rs' Identification: �f�s1 �1�(�'l l �� I�
rs' 1'/i� Fence Addendum Updated 1/14/2021
n City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233 PERMIT#
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: Date:
/ fiver
Property Type: Lot Type/ Features:
tO4esidential 42-tine Street frontage (interior lot)
❑ Commercial El More than one street frontage(corner lot,through lot,
etc.)
swimming Pool
Fence Material: Fence Height (select all that apply):
'Cr food [I34our Foot(4ft)
❑ Chain Link ❑ Six Foot(6ft)
❑ Vinyl ❑ Other
❑ Block/Stone (Plan details required for footings and/or
retaining walls)
❑ Other
Fence Location:
Please submit an accurate and current boundary survey showing all existing improvements(including building footprint,
driveway,swimming pool,etc.) and location of fence/wall and any gates. Plan details required for block wall footings and/or
retaining walls and any portion or fencing above 6ft in height.
Will the fence be built in an easement?
❑ Yes (must submit separate Revocable Encroachment Agreement)
Will tree(s) be removed in association with proposed project?
❑ Yes (must submit separate Tree Removal Permit)
No
Conditions of Approval:
• Roll off container company must be on City approved list. Roll off container cannot be placed on City right-of-way.
• All old fencing and debris must be removed from job site by contractor or homeowner.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.